EHR Info Overload Plagues Primary Care Docs

"I should be so lucky as to have only 77 messages"

Action Points

Inbox notifications from electronic health records (EHRs) averaged 77 notifications per day for primary care physicians, 29 notifications for specialists, and exceeded 100 for some PCPs in 2015, a small study reported.

Inbox notifications from electronic health records (EHRs) exceeded 100 per day for some primary care physicians (PCPs) during the first half of 2015, a small study reported.

Across three large practices in Texas, 46 PCPs received an average of 77 notifications per day, and 46 specialists received a mean 29 notifications per day, including responses to referrals, requests for medication refills, and messages from other healthcare professionals, reported Daniel R. Murphy, MD, MBA, of Baylor College of Medicine in Houston, and colleagues.

At two sites, notifications for PCPs averaged in the mid-60s, but at one site, the average was 114 per day, they wrote in a research letter inJAMA Internal Medicine.

"Extrapolating this finding to commercial EHRs suggests that physicians spend an estimated 66.8 minutes per day processing notifications, which likely adds a substantial burden to their workday," the authors wrote.

There also was a correlation between time worked and normalized daily total of notifications received, and part-time physicians received more notifications for the amount of time they spent in the clinic compared with full-time physicians (P=0.008), they noted.

"Given that it takes approximately 1 minute to manage each notification, the average primary care physician is spending more than 1 hour each day, uncompensated, handling these electronic communications, positioned at the computer instead of facing the patient," commented Joseph S. Ross, MD, MHS, of Yale School of Medicine, in an accompanying editor's note.

"Moreover, inbox notification capabilities should be periodically reviewed to be sure that this component of the EHR is working in the best interests of patient care and not creating an unnecessary burden on physicians," he added.

Murphy's team looked at electronic logs for all of the notifications received by every physicians employed at two primary care and one multispecialty practices in Texas across 6 months in 2015.

To account for variations in hours worked, percentages of notifications and hours worked were normalized and treated as full-time. However, to meet inclusion criteria, physicians had to work at least 20% of a 40-hour work week for the entire 6-month study period.

Overall, 92 physicians received 276,207 notifications. Epic's In-Basket was used at site A by 19 PCPs and 46 specialists, and 15 PCPs at site C. General Electric Centricity's Documents was used by 12 PCPs at site B.

This "information overload," is a growing concern because messages such as "FYIs" can be easily created in an EHR system versus a paper-based system, the authors noted.

"I completely agree with the authors that because it is easier to share information, that also increases the amount of information that is shared," Nancy Lynn Keating, MD, of Harvard Medical School and Brigham and Women's Hospital, told MedPage Today in an email. "Yet it remains challenging for physicians to separate the important information from the unimportant."

Rosalind Kaplan, MD, of Thomas Jefferson University in Philadelphia, said she feels the burden of this information overload. "If I take a day off, I still spend at least an hour on my inbox," Kaplan told MedPage Today in an email. "I feel ruled by it, and between notes and inbox, feel I spend more time at the computer than I do with patients."

She explained that the EHR system used at her institution does not organize messages into categories, such as "unfinished notes, patient callbacks, and medication refills. Consequently, there is no prioritization and I have to do that myself, which could cause errors or missed important messages."

Previous research done at a VA medical center reported that large quantities of EHR-based notifications made it difficult for healthcare professionals to discern important -- such as abnormal test results -- from irrelevant information, according to the study authors.

Richard Roberts, MD, JD, of the University of Wisconsin in Belleville, told MedPage Today that he was concerned about the increased risk for miscommunication and medical error.

"I should be so lucky as to have only 77 in-basket messages; it averages way over 100 for me, more like 110 to 140," he said in a phone interview. "The more time I spend fussing with in-basket, the less time I spend talking to patients. It never ends; it's a constant, and that gets discouraging for docs."

According to the researchers, for PCPs, 20% of the notifications involved test results compared with roughly 33% for specialists.

Electronic messaging can help PCPs foster relationships with patients, noted Joshua D. Septimus, MD, of Houston Methodist Hospital. He said his time online may not be that different from the amount of time he spends on "real" paperwork.

Septimus said he's learned to adapt to "patient on the right, computer on the left," adding that "you have to be willing to be online, but you also have to be willing to communicate with your patients."

The study was funded by the Agency for Healthcare Research and Quality (AHRQ) and the the Houston Veterans Affairs Health Services Research and Development Service Center for Innovations in Quality, Effectiveness and Safety.

Murphy disclosed support from an AHRQ Mentored Career Development Award. A co-author disclosed support from a Presidential Early Career Award for Scientists and Engineers, the Veterans Affairs Health Services Research and Development Service, and the Veterans Affairs National Center for Patient Safety.

Murphy and co-authors disclosed no relevant relationships with industry.

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